| NPI | 1417041369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS040287) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 050233) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2015-04-02 |